Chlamydial Infections Presentation PDF

CHLAMYDIAL INFECTIONS Dr EBEDE SO  Course outline & learning objectives Classification Introduction Species Chlamydia trachomatis Chlamydia psittacii Chlamydia pneumoniae Treatment Prevention  Classification Phylum - ch...

CHLAMYDIAL INFECTIONS Dr EBEDE SO  Course outline & learning objectives Classification Introduction Species Chlamydia trachomatis Chlamydia psittacii Chlamydia pneumoniae Treatment Prevention  Classification Phylum - chlamydiae Class - chjamydiae Order - chlamydiale Family - chlamydiacae One genus - chlamydia Species - C. trachomatics, C. psittaci, C. pneumoniae.  Introduction The chlamydiae consist of obligate intracellular pathogens. Small round to oval cells once believed to be large viruses. Obligate intracellular bacteria like viruses Bacteria with features of Gram –ve cell wall Possess rigid cell wall lacking peptidoglycan, otherwise resemble GNB cell wall. Contain both RNA & DNA Susceptible to some antibacterial agents : tetracylines, erythromycin  Lack enough energy machinery for independent existence. Cannot synthesize ATP Can no oxidize NADH Reproduction by replicative cycle, later binary fission unlike other bacteria Highly infectious Most species produce heat labile toxins  Introduction continues Exist in 2 forms: = Elementary bodies (EB) - extracelluiar, infectious, invasive stage, metabolically inert, enter the body by endocytosis a process similar to phagocytosis. =Reticulate Bodies (RB) or initial bodies (IB) - intracellular, non-infectious, metabolically active. When EB undergo changes, they reorganize into IB which is less dense than EB. Energy/ ATP for this process is from the host cell, takes about 24-72 hours. RB undergoes binary fission within the intra-cytoplasmic vacuole/ phagosome of the host cells, host cell rupture to to release daughter E Bodies, which infect other cells Morphology- highly pleomorphic Morphology: Small round to oval cells Microscopy: Electron microscopy when stained with Giemsa but better visualized when stained with iodine where they appear brown identified by their characteristic inclusion bodies within the host cell Culture: Grown in the laboratory in yolk sac of embryo of chicken egg Elementary bodies extracellular, Reticulate Bodies (RB) or (EB) initial bodies (IB) infectious, - intracellular, invasive stage, - non-infectious, - Non invasive metabolically inert, - metabolically acti enter the body by When EB undergo changes, they reorganize into IB which is less dense endocytosis a process than EB. Energy/ ATP for this process is from the host cell, takes about 24- similar to 72 hours. RB undergoes binary fission within phagocytosis. the intra-cytoplasmic vacuole/ phagosome of the host cells, host cell rupture to to release daughter E Bodies, which infect other cells  Three species based on these parameters Parameter C. C. psittaci C. trachomatis pneomoniae +/- glycogen in intra- present absent absent cytoplasmic inclusion body Sensitivity to sulhponamide sensitive resistant resistant Disease Trachoma A, Psittacosis Atypical spectrum B, C (man) pneumonia Genital inf D- Ornithosis TWAR 1989 K (birds) LGV Pneumonia L1- L3 Meningopneum LRTI onia Pneumonia Host Humans Birds, humans Humans  Chlamydia trachomatis infections Ocular infections =Trachoma - serotypes A,B,C =Inclusion conjunctivitis - serotypes D-K Genital infections - serotypes D-K  Chlamydia trachomatis infections Ocular infections: Trachoma - serotypes A, B,C Inclusion conjunctivitis - serotypes D-K Genital infections - serotypes D-K LGV - serotypes L1-L3 LRTI  Trachoma Specific communicable chronic kerato- conjunctivitis caused by C. trachomatis subtypes A-C. Common cause of avoidable/preventable blindness in the world. Transmission : direct contact, indirect contact via fomites, during birth via infected genital and birth passages. Commonest in children in endemic areas  Incidence and severity varies in different geographical regions. Incubation period 3-10 days. Infection may last for years and there may be recrudescence.  Clinical features Onset usually insidious and infection. Early symptoms include conjunctival irritation, lacrimation, blepharospasm, mucopurulent discharge but the problem may not be detected until vision begins to fail. Trachoma may present as acute ophthalmia neonatorum.  pathology Conjunctiva of upper lid first affected Vascularization and cellular infiltration Scarring causes lids inversion (entropion). Lashes rub against the cornea (trichiasis) Cornea becomes vascularized and opaque. Blindness becomes imminent.  Inclusion conjunctivitis Acute ocular suppurative disease of the conjunctiva due to infection by C. trachomatis serotype D-K. Occur in infants and adults. Incubation period 2-5 days. Presents as muco-purulent eye discharge. Transmission is by direct and indirect contact. Treatment- topical application of  Genital infections Genital C. trachomatis infection is a common cause of STI worldwide. Common among sexually active teenagers and young adults. 75% of infected women and 50% of men are asymptomatic and ignorant of the infection. Transmission is via oral, vaginal, anal sex, inclusion conjunctivitis and neonatal pneumonia in newborn babies of infected mothers.  Genital chlamydial infections cont. Non Gonococcal Urethritis (40-60% NGU). Easily confused with gonorrhea. ᴥNote UAC Rarely both can occur together. Cervicitis, epididymitis Salpingitis, endometritis Pelvic inflammatory disease (PID). Proctitis Pharyngitis Reiter’s syndrome Sub-fertility. Infertility/ sterility Chlamydial urethritis  Diagnosis Clinical diagnosis Laboratory diagnosis: specimens: post-voidal urine, urethral swab, endometrial scrapping, culdocentesis /aspiration of uterine tubes, endometrial scraping, conjunctiva scraping, posterior nasopharyngeal swab, tracheal/ bronchial aspirates Urine tests ready in 24hrs. Detection of C. trachomatis genes from urine and genital samples. Culture in McCoy cells to look out for C. trachomatis. Takes 3 days and above, expertise & experience needed. DFA test, Enzyme immunoassay.  Treatment/ complications Early detection and treatment Use of tetracycline, doxycycline, minocycline, erythromycin and azithromycin. Complications: HIV/AIDS, PID, subfertility, infertility.  Prevention and control Routine use of prophylactic ophthalmic eye drops for newborns, oral tetracycline or sulfonamides. Personal and family hygiene. Population survey Establishment of trachoma clinics  LYMPHOGRANULOMA VENERUM LGV is caused by unique serovars of Chlamydia trachomatis (L1, L2, L3) that are unlike those that typically cause urethritis, cervicitis, and proctitis ( D-K) Its presentation varies depending on the site of infection. The incubation period is between 3 days and 1 month after exposure.  LGV is an invasive, systemic infection that progresses in 3 stages. The Primary (Ulcer) stage is marked by the formation of a painless vesiculo-papular ulceration that resembles a herpes lesion at the site of inoculation. The ulcer heals on its own in few days. LGV Picture  Chlamydia psittaci Pathogenic to birds and domestic fowls especially psittacine, parachid birds. Natural disease of birds particularly psittacine birds e.g. Parrots, parachid birds (pigeon) and others (ornithosis), domestic fowls Transmission to humans is inhalation of bacteria from their droppings Zoonotic human disease of the lower respiratory tract (psittacosis), that ranges from subclinical to lethal pneumonia and meningo-pneumonitis. Occupational disease associated with raising and processing poultry. Organism has intra-cytoplasmic inclusions without glycogen. Cannot synthesize glycogen  Laboratory diagnosis Usually on the basis of patients history and clinical symptoms Aided by Fluorescent monoclonal antibody staining of Elementary bodies in exudates.  Treatment and control Drug of choice- Tetracycline Prevention is by improved hygienic standard Proper handling of poultry and poultry products Quarantine/ treatment of psittacine birds.  3.] C. pneumoniae Very common world wide, 30-50% of people have antibody to C. pneumoniae. Intra-cytoplasmic inclusion lack glycogen. Resistant to sulfonamide. Airborne transmission. No known animal reservoir Most infections are asymptomatic. Causes LRTI, URTI including atypical pneumoniae, bronchitis, sinusitis, pharyngitis, exacerbation of asthma.  Laboratory diagnosis Specimens – sputum,nasal secretions, blood, bronchoalveolar lavage fluid, biopsy. Cell culture grows better at 35 than 37 degrees cent , detect with Flourescent antibody test after 3 days. Serology- Micro-immune Flourescent test to detect IgG or IgM antibodies. Nucleic Acid Amplification (NAA)  Treatment Tetracycline, erythromycin Question time ??????? Appreciation Dalu nu !